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New treatments prolonging lives

Attendees at a cancer seminar in Singapore heard about the latest in cancer treatments available to people with breast, ovarian, endometrial, lung and blood cancers.

Even as cancer becomes more common in Singapore, researchers have discovered ways to prolong the lives of cancer patients.

That was the message given during a seminar titled Understanding Cancer and Beyond, which was organised by Channel NewAsia and Parkway Cancer Centre (PCC) at the Pan Pacific Singapore hotel on 29 July.

Dr Khoo Kei Siong, the Deputy Medical Director of PCC, noted that since the 1970s, cancer survival rates in general have gone up from 25 per cent to 50 per cent.

However, treatments for certain cancers have seen more progress than others. Patients with cancers such as testicular cancer, melanoma, prostate cancer, Hodgkin’s lymphoma, breast cancer and uterine cancer are surviving much longer than before.

However, treatments for liver cancer and pancreatic cancer have not progressed as much.

He said that improvements in treatment have been due to three reasons: earlier detection, effective treatment of micrometastases and better understanding of the biology of cancer.

Micrometastases is when the cancer has spread but it cannot be seen, even with sophisticated scans. With better chemotherapy drugs and new treatments like targeted therapy and immunotherapy, micrometastases can be more effectively treated and mortality reduced, he said.

A better understanding of the biology of cancer cells also allows doctors to attack cancer cells more accurately and effectively. Targeted therapy, for example, looks for specific biomarkers that identify a particular kind of cancer to find the drug most effective against it.

Targeted therapy and immunotherapy, have also given doctors more tools to fight cancer. Immunotherapy uses the body’s immune system to recognise and fight cancer cells.

“Because of these trends,” said Dr Khoo Kei Siong, “we suspect that cancer treatment will become increasingly tailored and individualised, based on genetic makeup and cancer characteristics.”

Dr See Hui Ti, a senior consultant in medical oncology, spoke about advances in the treatment for cancers specific to women. On breast cancer, she noted that doctors now know who will not benefit from chemotherapy, who will benefit from chemotherapy before surgery and how to reduce the risk of getting cancer.

Through a genetic array test, oncologists now know which types of breast cancer are low risk and thus do not need chemotherapy.

Doctors can now also determine who will benefit from getting chemotherapy before surgery. Some types of breast cancer are very aggressive but respond well to chemotherapy. By doing chemotherapy before surgery, the operation can conserve the breast. It also means that we know how well the cancer responds to chemotherapy.

Some patients will also benefit from risk-reducing surgery. For example, patients who have a high risk of getting breast cancer, the cancer can be detected by testing them for a genetic mutation. Likewise, some women have a genetic mutation which puts them at a high risk of getting ovarian cancer. For these women, the only way to reduce the risk is to remove both ovaries and the fallopian tubes before the cancer develops.

On endometrial (womb) cancer, genetic array testing held a lot of promise, she said. In future, it may allow doctors to use a simple test to identify the kind of endometrial cancer that a patient has. As a result, some women might not even need surgery if they had a very slow growing cancer.

On his part, Dr Lim ZiYi, a senior consultant in haematology, spoke about a kind of immunotherapy called cell therapy. He talked about how T-cells, which the body uses to fight infection, can be armed with a Chimeric Antigen Receptor (CAR) so that it can find and kill cancer more effectively.

He recounted the 2015 case of a baby with very aggressive leukaemia who received 1ml of CAR T cells after all conventional treatments failed. “In the fourth or fifth week, the leukaemia cells started melting away,” he noted.

So far, there has been very good data on using cellular therapy for blood cancers such as acute lymphoblastic leukaemia, lymphoma and myeloma, he said. Researchers are now looking at using cell therapies on solid tumours.

“We believe that cell therapy is going to be very important going forward, for the field of treating cancer,” said Dr Lim. That is why PCC was looking to bring cellular therapy to the masses in the next few years, he said.

Dr Lim Hong Liang, a senior consultant in medical oncology, talked about how the treatment of lung cancer had improved, thanks to targeted treatment and immunotherapy.

He noted that for mutation-positive lung cancer, targeted therapy and chemotherapy treatment improved the median survival time to 2.5 to three years, compared to 12 months from just chemotherapy alone.

In addition, newer forms of immunotherapy such as anti-PD-1 checkpoint inhibitors had shown to be able to further improve the survival of advanced lung cancer patients.

He said he was very excited because it was an additional mode of treatment that was well tolerated and had longer response durations compared to chemotherapy and targeted therapy. With immunotherapy, the five-year survival rate for lung cancer was 16 per cent, compared to five per cent without immunotherapy.

Following the presentations, there were panel discussions that covered a wide range of issues. Among the questions raised were whether stress caused cancer. In response, Dr See said efforts to prove a direct link between stress and cancer had failed. However, she noted, stress could lead to activities and lifestyles that could cause cancer such as smoking and overeating.

Dr Lim ZiYi added that cancer is multifactorial, it could be genetic or due to the environment, or to diet or smoking. His advice? In all things, moderation.

Another question asked was whether there were diets that could prevent cancer. Senior Dietitian Fahma Sunarja said that the best way to lower cancer risk was to avoid being overweight, to be active, to eat more plant-based foods, and to limit the consumption of energy-dense foods, processed meat and salted and preserved foods.

Cancer treatment: The good news

Cancer survival rates have risen from 25 per cent to 50 per cent over the past 40 or so years. Recent breakthroughs spell even better news for some common cancers.

Breast cancer: Genetic array tests can help reveal low-risk types of breast cancer that may not require chemotherapy.

Blood cancer: The use of cellular therapy to treat blood cancers such as acute lymphoblastic leukaemia, lymphoma and myeloma looks promising.

Lung cancer: Immunotherapy has improved the five-year survival rate for lung cancer, from five per cent to 16 per cent.

What you can do

• Avoid activities and lifestyles that can cause cancer, such as smoking and overeating.
• Keep your weight down.
• Stay active.
• Eat more plant-based foods.
• Limit the consumption of energy-dense foods, processed meat, and salted and preserved foods.

Written by Jimmy Yap